TOPICS > Health

Protecting the Youngest

May 6, 1997 at 12:00 AM EDT


MARGARET WARNER: There are an estimated 10 million children in the United States who have no health insurance at all. The vast majority of them are from working families, since children on welfare are automatically eligible for Medicaid. One-third of the uninsured children are eligible for Medicaid too, because of their families’ low income, but their parents have not enrolled them. The result, say health experts, is that these uninsured children get virtually no medical care until they end up in hospital emergency rooms with serious problems. Should the federal government get involved in covering these children? The President and some members of Congress, say yes and have introduced proposals to address the problem in a variety of ways.

PRESIDENT CLINTON: Forty million Americans still lack health insurance. Ten million children still lack health insurance. Eighty percent of them have working parents who pay taxes. That is wrong.

MARGARET WARNER: The first major proposal came from President Clinton in his State of the Union address. His plan seeks to expand both Medicaid and private insurance for kids; it would enroll one and a half million children already eligible for Medicaid who haven’t been signed up; give states $12 billion to subsidize private coverage for uninsured working families and those temporarily out-of-work; extend Medicaid coverage to 1 million 13 to 18-year-olds in the lowest income families–a proposal already passed by Congress. The program would cost $19 billion over five years.

SEN. ORRIN HATCH, (R) Utah: Thank you. And good morning to everyone.

MARGARET WARNER: Republican Senator Orrin Hatch and Democratic Senator Ted Kennedy have a rival plan. In April, Sen. Hatch described the families his bill is aimed at.

SEN. ORRIN HATCH: These families are the working poor of our country; they are the poorest of the poor not on Medicaid; they are respectable and hard working people who pay taxes, work hard to put food on the table and on the kitchen table, and who struggle each day to provide hope and opportunity for their children. These children oft times go without many of the possessions that most young people in our society enjoy. Parents should not have to decide whether to buy health insurance for their children or put food on the table. They shouldn’t have to make that sole choice.

MARGARET WARNER: The Hatch/Kennedy bill focuses on expanding private insurance alone. It would give the states block grants worth $20 billion over 5 years to subsidize private insurance for up to 5 million children; pay for the program by increasing the federal cigarette tax by 43 cents a pack. The Republican leadership in Congress criticized the Hatch-Kennedy bill as just another big government tax hike. But the bill has gained six more Republican co-sponsors. Two weeks ago Republican Senator John Chafee and Democratic Senator Jay Rockefeller came up with yet another idea. Their plan focuses on expanding Medicaid alone.

SEN. JOHN D. ROCKEFELLER, (D) West Virginia: We’re going to do this building on Medicaid, because Medicaid is something that states understand; that families understand; that’s not new, that the bureaucracy understands, even though Medicaid isn’t working as well, and doesn’t reach as many as it should. It is not a new program, and it also targets, by definition, a certain income level, which is the floor that we wish to establish beneath which children cannot fall.

MARGARET WARNER: The Rockefeller/Chafee plan would give matching federal funds to states to extend Medicaid to cover children in families earning up to 150 percent of the poverty level; give $25 million to states to enroll eligible children in Medicaid who haven’t been signed up. Still other congressional alternatives focus on using tax credits and/or vouchers to help poor working families pay for private health insurance. When the White House and Republican Congressional leaders announced a budget deal last Friday, the framework they adopted included at least $16 billion to expand children’s health coverage but the deal didn’t endorse any specific plan or approach. While Washington has been debating the issue, some states have forged ahead on their own. Some have loosened the eligibility rules for Medicaid. Others have combined Medicaid expansion with subsidies for private insurance.